Kentucky Medicaid Changes

[xChdx 15]

Hey all, I'm new. Long story short I just got told by my would've been surgeon's office (Dr. Weiss at CBH) that as of January 1st 2014, KY Medicaid no longer covers bariatric surgery. I was so close to finally getting something done, but the very day my insurance went active was the very day they stopped covering what I needed it for in the first place. Oh well, that's life eh? I guess they'd rather spend that money on my future heart attack and stroke treatments.

Anyway just thought I would stop by and pass along the information. I hadn't read about this anywhere else on the web, so I thought there might be others who need to know.

Regards.

[kyflower75 2]

I called and ask Kentucky Medicaid and Anthem who is my medicaid carrier. They are still covering Bariatric surgeries. Wellcare had decided not to carry it anymore but I don't know if that's still the case.

[kyflower75 2]

Look at this...

http://chfs.ky.gov/NR/rdonlyres/83A81841-1580-4122-AA04-F50B9AE0576F/0/BariatricSurgery_LettertoProviders_v22.pdf

[xChdx 15]

Well this is definitely interesting. I have Passport, and was also told (as far as the rep was aware anyway) that there was no change. And yet I've been told by two different surgeon's offices that medicaid was no longer covering weight loss surgeries. Maybe I should make a few more calls and figure this out.

Thank you so much for the info!

[dharriott 37]

What this means is if you get denied.. You can appeal and it can be overturned and approved. If you have two health issues from being obese, and a BMI of 35 you will be covered.

[xChdx 15]

Okay, I know it's been a while, but I have good news. Long story short, KYflower75's info is correct, Medicaid is in fact still covering weight loss surgery in Kentucky. The whole thing was a matter of miscommunication between Medicaid and the Surgeon's office. So as of today I have completed and submitted all the paperwork necessary to get the process started.

[ladycynjj 31]

Okay, I know it's been a while, but I have good news. Long story short, KYflower75's info is correct, Medicaid is in fact still covering weight loss surgery in Kentucky. The whole thing was a matter of miscommunication between Medicaid and the Surgeon's office. So as of today I have completed and submitted all the paperwork necessary to get the process started.

Glad you got everything straighten out...I will be meeting with my Dr in LExington on the 26th..Medicaid in covering mine also..happy things back on track for you.

[heav85 123]

I hope someone sees this... Im new to this board and just started here from a google search. But I am on wellcare and going to get the process started monday. But with wellcare I have to go through 6 months of medical weight loss first.... I was just wondering if anyone else has gone thru this and if after the 6 months you got to have the surgery?

[chuck415 89]

Hey has anyone here with Kentucky Medicaid had the surgery? Who was your MCO? What was the approval process like? How much did it cost you out of pocket? Thanks in advance.

[Eclectick 129]

Insurance Carriers are different, some do 6 months with a NUT, some do 3 Months or if you can document the last year or two of diet programs with your general practitioner they sometimes waive the pre-op NUT visits...it depends.

As for me, I have BCBS - Blue Choice Advantage through insurance at work, and they require 6 months...unless I could prove I was on a doctor supervised diet for a year or two and failed, which I couldn't....with that being said..if you have the option of doing the 6 months...I would recommend it...it's very informative, and your monthly NUT appointments are and will be very helpful in the long run.

[zombie.Liz 0]

I have coventry cares through medicaid and I am looking into getting the gastric sleeve, does anyone know if they cover this? BMI is 60, I am 6 foot 1 and 456lbs and have high blood pressure, asmah, sleep apnea and type 2 diabetes

[ab123. 90]

I have coventry cares through medicaid and I am looking into getting the gastric sleeve, does anyone know if they cover this? BMI is 60, I am 6 foot 1 and 456lbs and have high blood pressure, asmah, sleep apnea and type 2 diabetes

I'm not sure what Medicaid covers. You can probably Google it but I have Coventry Advantra Medicare in Louisiana and they cover it with a BMI > 35 and 2 co-morbidities. sleep Apnea diabetes would count as the 2.

[raec81 18]

I'm not sure. I had mine done with WellCare and was approved the day after my packet was submitted. Stay away from BCBS they gave me months of headache and heartache. Try calling your customer service number. The criteria for most insurance is a BMI of 40+ with no comorbid condition or 35+ with. There's always the one that's different but overall those seem to be the general guidelines. Since yours is over 40 and you also have a comorbid you should qualify once you jump through their hoops if they cover it. Good luck.

Edited February 20, 2015 by raec81

[zombie.Liz 0]

I'm not sure. I had mine done with WellCare and was approved the day after my packet was submitted. Stay away from BCBS they gave me months of headache and heartache. Try calling your customer service number. The criteria for most insurance is a BMI of 40+ with no comorbid condition or 35+ with. There's always the one that's different but overall those seem to be the general guidelines. Since yours is over 40 and you also have a comorbid you should qualify once you jump through their hoops if they cover it. Good luck.

Thank you

But what is bcbs?

[raec81 18]

Anthem Blue Cross Blue Shield. I had nothing but a headache and runaround from them.